文档介绍：Chest physiotherapy in the management of ICU patients immediately after extubation
Sahar Elkaradawy
Assistant Professor in Anaesthesia and Intensive Care Unite.
Weaning from ventilation
Weaning process is a liberation of patient from ventilator, after resolution of illness.
Role of physiotherapist after extubation
Physiotherapists are often involved in the weaning from ventilation to:
assist patients to maintain a good respiratory function
prevent re-intubation.
Standardized weaning protocol
Mechanical ventilation should be discontinued under the direction of one of three board,
certified critical care physicians
respiratory therapists
nursing staff.
Criteria for weaning from ventilation
Cooperative and pain free
Good cough reflex to tracheal suctioning
Minimal secretion
PaO2to FIO2 ratio >24 kPa > 200 , minute ventilation ≤12 l
PEEP <5 cm H2O
Hb >7 g dl±1
Axillary temperature between 36 and °C
Plasma K+ concentration > and < mmol litre±1
Plasma Na+ concentration >128 and <150 mmol litre±1
Inotropes reduced or unchanged over previous 24 h
Spontaneous ventilatory frequency >6 min±
Evaluation of the cough strength
The cough strength mand (0 to 5) and amount of endotracheal secretions (none to abundant). Patients are asked to cough onto a white card through the endotracheal tube. If secretions were propelled onto the card, it is termed a positive white card test (WCT). Patients with weak (grade 0 to 2) coughs and abundant secretions were more likely to fail extubation.
Extubation failure
Extubation failure-need for reintubation within 72 h of extubation, mon in intensive care unit (ICU).
The impact of extubation faliure :
increased morbidity, higher costs, higher ICU and hospital length of stay (LOS) and mortality.
Risk factors for re-intubation
Patients with advanced age.
High severity of illness at ICU admission and extubation.
ICU factors:
Deconditioned muscles, poor nutrition, upper airway edema due to prolonged translaryngeal intubat